America's older population is growing at an unprecedented rate. The number of people 65 or older is larger than ever before, and the over-85 group is the fastest growing segment of the population. When the baby boom generation enters its senior years, between 2010 and 2030, it is projected that one in five Americans will be over 65.
With this "graying of America" comes not only the demand for physicians and other health care professionals with expertise in geriatrics, but also a huge growth in the number of caregivers: family and friends who can help older loved ones live longer and healthier lives.
But what is geriatrics?
Geriatrics and the Role of the Geriatrician
Geriatric medicine focuses on health promotion and the treatment of disease and disability in later life. A geriatrician is a physician who is specially trained to prevent and manage the unique and often multiple health problems of older adults, such as chronic pain, heart disease, memory loss, and osteoporosis.
Geriatricians understand the specific ailments older patients experience, as well the complexity of managing multiple diseases, and use their expertise to develop appropriate care plans
Most geriatricians are internists and family physicians who have been certified in geriatric medicine. These physicians hold a Certificate of Added Qualification in Geriatric Medicine (CAQGM). In order to become certified a resident must complete a fellowship program. Programs require either one or two years of training.
The basic philosophy of geriatric care is set by the patients themselves. Older people don't expect a cure they do expect wise advice and purposeful guidance. That's what medicine is all about, and what makes it so rewarding. Geriatricians have to do this in a modern medical environment and apply these principles to patients who are frail and vulnerable. We have to help them through crises, help them deal with death and dying, and help their families deal with death and dying. In many of these cases you are very much a part of the family. Of all the disciplines of medicine, it is hard to imagine one that is more enriching, more filled with variety, or more rewarding. People working in this field feel that geriatrics is the best of medicine, combining the best of old-fashioned medicine and modern scientific medicine - generalists in the most complex of situations.
The Team Approach
Ideally, a geriatrician will lead a team of health care professionals in the medical evaluation of an older person. This geriatrics team may include a nurse, social worker, nutritionist, physical therapist, consultant pharmacist, and geropsychiatrist. The team considers the individual's medical history and present condition, and looks for the effects of both past illnesses and what are known as "geriatric syndromes" -- common conditions in frail elderly patients such as incontinence, frequent falls, confusion, and the side effects caused by multiple medications.
In addition, the geriatrics team evaluates the social support available to a patient, such as a spouse, children or friends. The team also considers the person's capacity to perform the simple activities of daily living (ADLs), such as bathing, dressing, and eating.
While the geriatrician functions as the "point person," each member of the team is a skilled health care professional who plays a vital role in the proper assessment and care of older people.
What career options are available for someone who trains as a geriatrician?
Geriatric medicine requires a full network of care programs, a full continuum of care. Care in the hospital, care in the subacute unit, care in the nursing home, care in the patient's home, care in the daycare center, and care in the retirement community. All of these are the arena of geriatric medicine. Now the dominant need is in chronic care and chronic disease management, and the geriatrician can do whatever the geriatrician wants to do. You can do ambulatory care, house calls, or see patients in the nursing home, hospital, or retirement communities. You can work in an HMO and help develop preventive strategies. Other arenas including being a teacher, a researcher, or working in public policy. Or you can do a little bit of all of them. The needs are there.
Adapted from the American Geriatrics brochure, "What is Geriatrics?"